The Reasons Of Pre-Hospital Delay In Patients With Stemi

Aim: The aim of this article is to assess the socio-demographic, personal, situational and time-related factors influencing the duration of the process of decision making of patients with acute coronary syndrome (ACS) when calling for help.Methods: 83 consecutive patients were included in our study while they were hospitalized at our ward during the period from 12/2018 to 3/2019 because of ST elevation myocardial infarction (STEMI). The patients filled in a questionnaire while its items were related to their knowledge of ACS and the reasons for the delay before they were admitted to the hospital (delay).Results: In total, 83 patients were included in our research (63 men and 20 women), the age median of the set was 63 years.Only 15 patients (18.1%) had their coronary arteries previously intervened. 38 patients (45.8%) were aware of ACS symptoms and the rest (43.4%, i.e. 36 patients) knew about at least two risk factors of coronary heart disease (CHD).The median of the time delay between the occurrence of symptoms and the contact of medical aid was 120 minutes. 55 patients (66.3%) called for help in less than 3 hours since their troubles started. The average age of men included in our study was 62.3 years and the median of the delay was 120 minutes among them. Whereas the average age among the women was 66.1 years and the delay before their admission was 165 minutes. The median among the people with tertiary education (n = 4) was 52.5 minutes, it was 120 minutes among patients with secondary education (n = 57) and it was 112.5 minutes among patients with primary education only (n = 22).The median of the delay among the patients who were aware of the symptoms of CHD (n = 38) was 120 minutes while it was the same also among the patients who were not aware of the symptoms (n = 45). Similarly, there was no difference in the median of the delay between the patients with a primomanifestation of CHD (n = 68) and the patients with a previously performed percutaneous coronary intervention (n = 15) - it was 120 minutes in both groups.The patients mentioned as the causes of the delay back aches (31.3%; n = 26), stomach aches (7.2%; n = 6), pulmonary difficulties (3.6%; n = 3); 19.3% of the patients (n = 16) did not want to bother the physician; 15.7% (n = 13) were not aware of the fact that the situation deserves an acute resolution; 8.4% of the patients (n = 7) did not have time to resolve the problems and 8.4% of the patients (n = 7) were afraid of a contact with a physician.Conclusion: In our group the median of the delay between the first occurrence of the symptoms and the first medical contact was 120 minutes. The confusion between ACS symptoms and a back ache was the most frequent cause of the delay. The patients who were older than 65 years of age, women and patients without higher education evince a longer delay. There was no difference in the delay between the patients who were aware of ACS symptoms (or CHD risk factors) and the patients who were not aware of ACS symptoms (or CHD risk factors). Similarly there was no difference between the patients with a primomanifestation of CHD and patients with a previously performed percutaneous coronary intervention.